Behavioral Intervention Works to Reduce Risky Behavior

In an effort to curb the rising rates of HIV and sexually transmitted infections (STIs) along the Mexico-US border, a binational team of researchers led by the University of California, San Diego School of Medicine have shown that brief but personalized behavioral counseling significantly reduced rates and improved condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico.

The researchers observed a 40 percent decline in the combined rate of new STIs (including HIV, syphilis, gonorrhea and chlamydia) in the group of female sex workers who received the 30-minute one-on-one counseling intervention, compared to an encounter that was based on educational information only. The study, headed by Thomas L. Patterson, Ph.D., professor of psychiatry at UC San Diego School of Medicine, in collaboration with researchers from across Mexico, at UC Davis and Northeastern University, will be published on line September 17 in advance of the November edition of the American Journal of Public Health.

“An advantage to the counseling approach is that – instead of simply listening to a lecture – women are taught and can practice skills that are tailored to their personal situations,” Patterson said. “By working with the counselor, women identify for themselves the barriers to safer sex and discuss potential solutions as part of their goal setting.”

The study looked at 924 female sex workers aged 18 years or older, without known HIV infection, living in Tijuana and Ciudad Juarez – approximately equal numbers in both cities – who had recently had unprotected sex with clients. Half of the women took part in the Mujer Segura (Healthy Woman) counseling session with specially trained, local health care staff. The others participated in a face-to-face informational session, with prevention materials drawn from the U.S. Centers for Disease Control and Prevention guidelines for HIV counseling, testing and referral and from Mexico’s National Center for AIDS Studies.

“The major difference in the two approaches is that the Mujer Segurasessions focused on the participants assessing their personal risk factors, such as having unprotected sex with clients, and developing strategies for reducing that risk,” said Patterson.

Counselors helped the participants identify and understand behaviors and circumstances that put her at risk for contracting HIV or other STIs. They also provided positive reinforcement, helping the women to set small and achievable goals and providing motivational techniques and role-playing to reinforce ways of practicing safe sex.

Individuals in the intervention group reported significant improvements in their risk behaviors. In particular, not a single incidence of HIV infection occurred in the intervention group.

“In the absence of an effective HIV vaccine in the near future, the urgent need continues for effective, culturally appropriate interventions that can be used as stand-alone programs, or to support existing approaches,” Patterson said. “Our brief intervention, which counselors can be easily trained to deliver in a variety of settings, is an inexpensive and effect approach to reducing the risk of HIV and other STIs.”

Studies show that current rates of HIV infection (at six percent of FSWs in Tijuana and Ciudad Juarez) and active cases of STIs (at 25 percent, with one out of four women having at least one of the following: gonorrhea, chlamydia, syphilis or HIV) are increasing at a rate of two percent per year.

“These are diseases that recognize no borders and this includes the U.S.-Mexico border, which has more human crossings than any other in the world. Therefore, it is critical that we work with health providers, not only in Mexico, but also in the U.S. border towns to inhibit this disturbing trend,” said contributor Hugo Staines-Orozco, director of the Institute of Biomedical Sciences at the Autonomous University of Ciudad Juarez.

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